What is a curettage/vacuum aspiration and is it necessary after an abortion with pills?
Vacuum aspiration, curettage, is a surgical intervention to remove the contents of the uterus. This treatment might be necessary if there are complications after medical abortion or spontaneous miscarriage.
However, in some countries, doctors are accustomed to performing a surgical treatment even though it might not be needed for medical reasons.
You do NOT need a vacuum aspiration if the ultrasound shows that there are still some small remains in the uterus (incomplete abortion) or experience some bleeding after 3 weeks AND you do not have any complaints like pain, fever or heavy bleeding. Small remains in the uterus can be treated with an extra dose of Misoprostol or you can just wait until your next menstruation; the uterus will most likely empty itself. Regular menstruation comes back 4 to 6 weeks after a medical abortion. After a normal menstruation you should not have any remaining tissue left in the uterus. However, in case you have severe complaints like high fever, persistent strong pain and increasing heavy bleeding, a surgical intervention called vacuum aspiration might be needed.
Some medical facilities still only do a procedure called D&C or sharp curettage: this should not be done! You can ask the doctor what kind of procedure will be used because they should perform a vacuum aspiration and not a sharp curettage or D&C (vacuum aspiration is less painful and has less risks and complications).
All procedures should be done under local or general anaesthesia!
Note: The word “curettage” might be used to signify “surgical evacuation of the uterus”, which can be done by vacuum aspiration or using a sharp curette. According to World Health Organization, the sharp curette should not be used anymore for first trimester (12 weeks) abortions. As this wording might be confusing, we prefer not to use the word “curettage”, when it means “surgical evacuation of the uterus”, and only use this word when “the sharp curette is being used for treatment”. However some doctors still use the word “curettage” while they mean “vacuum aspiration”.
According to the World Health Organization, “if the person is feeling well, neither prolonged bleeding nor the presence of tissue in the uterus (as detected by ultrasound) is an indication for surgical intervention. Remaining products of conception will be expelled during subsequent vaginal bleeding. Surgical evacuation of the uterus may be carried out if the bleeding is too heavy or prolonged, causes anaemia, or if there is evidence of infection.”
If the results of an ultrasound reveal remains in the uterus but you feel well, it’s best to wait a few more weeks. If you start to observe signs of complications, you should go back to the doctor immediately. If you suspect a complication, please read "How do you know if you have a complication and what should you do?"
In case of diagnosed complications, a vacuum aspiration could be needed. Dilatation and curettage can only be used if vacuum aspiration is not available. Vacuum aspiration is a newer and much safer surgical method and you should always ask for it if you are given a choice between vacuum aspiration and sharp curettage.